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Point-of-Care Ultrasound in Resource-Limited Settings

Beam M, Abdull Wahab SF, Ramos M

Med Clin North Am, 2025 Jan;109(1):313-324.
PMID: 39567101 DOI: 10.1016/j.mcna.2024.06.005

Point-of-care ultrasound (POCUS) bridges diagnostic gaps across the continuum of care worldwide and is a particularly potent tool in resource-limited settings (RLS). To capture the scope of its current impact in RLS, this narrative review of POCUS use in public health, primary care, outpatient specialty, pre-hospital, and palliative care settings discusses its use in reducing diagnostic health care inequities. Disease-specific protocols, longitudinal training, quality assurance, and task shifting are key to robust expansion of POCUS in RLS.
Fulltext Ketamine-propofol (Ketofol) for procedural sedation and analgesia in children: a systematic review and meta-analysis

Foo TY, Mohd Noor N, Yazid MB, Fauzi MH, Abdull Wahab SF, Ahmad MZ

BMC Emerg Med, 2020 10 08;20(1):81.
PMID: 33032544 DOI: 10.1186/s12873-020-00373-4

OBJECTIVES: The aim of this review is to elucidate the efficacy and side effects of ketofol in comparison to other anaesthetic agents during procedural sedation and analgesia.
METHOD: The Cochrane Central Register of Controlled Trials (1996 to Feb 2019) and MEDLINE (1966 to Feb 2019) were searched, including the related randomised control trials and reviewed articles to find unpublished trials or trials not obtained via electronic searches. Inclusion criteria for the studies included comparing recovery time, recording clinician satisfaction, and assessing the adverse effects of ketofol.
RESULTS: Eleven trials consisting of a total of 1274 patients met our criteria and were included in this meta-analysis. Five trials compared ketofol with a single agent, while six trials compared ketofol with combined agents. While comparing between ketofol and a single agent (either ketamine or propofol), ketofol showed significant effect on recovery time (MD: -9.88, 95% CI: - 14.30 to - 5.46; P = 0.0003; I2 = 92%). However, no significant difference was observed while comparing ketofol with combined agents (RR: 0.75, 95% CI: - 6.24 to 7.74; P < 0.001; I2 = 98%). During single-agent comparison, ketofol showed no significant differences in terms of clinician satisfaction (RR: 2.86, 95% CI: 0.64 to 12.69; P = 0.001; I2 = 90%), airway obstruction (RR: 0.72, 95% CI: 0.35 to 11.48; P = 0.81; I2 = 0%), apnoea (RR: 0.9, 95% CI: 0.33 to 2.44; P = 0.88; I2 = 0%), desaturation (RR: 1.11, 95% CI: 0.64 to 1.94; P = 0.28; I2 = 21%), nausea (RR: 0.52, 95% CI: 0.91 to 1.41; P = 0.2; I2 = 38%), and vomiting (RR: 0.63, 95% CI: 0.25 to 1.61; P = 0.18; I2 = 42%). During comparison with combined agents, ketofol was more effective in reducing hypotension (RR: 4.2, 95% CI: 0.2 to 0.85; P = 0.76; I2 = 0%), but no differences were observed in terms of bradycardia (RR: 0.70, 95% CI: 0.14 to 03.63; P = 0.09; I2 = 53%), desaturation (RR: 1.9, 95% CI: 0.15 to 23.6; P = 0.11; I2 = 61%), and respiratory depression (RR: 1.98, 95% CI: 0.18 to 21.94; P = 0.12; I2 = 59%).
CONCLUSION: There is low certainty of evidence that ketofol improves recovery time and moderate certainty of evidence that it reduces the frequency of hypotension. There was no significant difference in terms of other adverse effects when compared to other either single or combined agents.
TRIAL REGISTRATION: PROSPERO CRD42019127278 .
Gastric ultrasonography in evaluating NPO status of pediatric patients in the emergency department

Azad AM, Al Madi HA, Abdull Wahab SF, Shokoohi H, Kang YJ, Liteplo AS

Am J Emerg Med, 2019 02;37(2):355-356.
PMID: 29903670 DOI: 10.1016/j.ajem.2018.06.013
Fulltext Supradiaphragmatic central venous catheter malposition detection using the parasternal long-axis echocardiographic view and dextrose 50% contrast solution: A pilot study

Che Rahim MJ, Abdull Wahab SF, Fauzi MH, Nadarajan C, Ab Hamid SA

Ultrasound, 2022 Nov;30(4):292-298.
PMID: 36969538 DOI: 10.1177/1742271X211051767

BACKGROUND: Contrast-enhanced ultrasonography (CEUS) using saline was studied to detect supradiaphragmatic central venous catheter malposition. Commonly used echocardiographic views are apical 4-chamber (A4c) and subcostal views. However, this standard method is not feasible in certain situations. We explored the feasibility of the right ventricle inflow parasternal long axis (RVI-PLAX) echocardiographic view and dextrose 50% (D50%) contrast solution for detecting supradiaphragmatic central venous catheter malposition.
METHOD: This pilot study screened 60 patients who underwent ultrasound-guided supradiaphragmatic central venous catheter insertion. We compared the investigators' guidewire's J-tip detection, D50% rapid atrial swirl sign (RASS) findings on the RVI-PLAX view and the central venous catheter tip on chest radiograph. We also compared the mean capillary blood sugar level before and after the 5 ml D50% flush.
RESULTS: No guidewire J-tips were detected from the RVI-PLAX view. The first and second investigators' diagnosis of central venous catheter malposition detected on RVI-PLAX CEUS achieved an almost perfect agreement (κ = 1.0 (95% confidence interval (CI): 0.90 to 1.0), p
Fulltext Intravenous parecoxib sodium as an analgesic alternative to morphine in acute trauma pain in the emergency department

Baharuddin KA, Rahman NH, Wahab SF, Halim NA, Ahmad R

Int J Emerg Med, 2014;7(1):2.
PMID: 24386899 DOI: 10.1186/1865-1380-7-2

BACKGROUND: Parecoxib sodium is the first parenteral COX-2 inhibitor used for pain management licensed for postoperative pain. However, no study has assessed the usage of parecoxib for acute traumatic pain in the emergency department (ED). The objective of this study was to investigate a potential alternative analgesic agent in the ED by determining the mean reduction of pain score between acute traumatic pain patients who were administered with intravenous (IV) parecoxib sodium versus IV morphine sulfate. The onset of perceptible analgesic effect and side effects were also evaluated.
METHODS: A randomized, double-blinded study comparing IV parecoxib 40 mg versus IV morphine at 0.10 mg/kg was conducted in adult patients presented with acute traumatic pain with numeric rating scale (NRS) of 6 or more within 6 hours of injury. Patients were randomized using a computer-generated randomization plan. Drug preparation and dispensing were performed by a pharmacist. Periodic assessment of blood pressure, pulse rate, oxygen saturation, and NRS were taken at 0, 5, 15, and 30 minute intervals after the administration of the study drug. The primary outcome was the reduction of NRS. Side effect and drug evaluation was conducted within 30 minutes of drug administration.
RESULTS: There was no statistically significant difference in the reduction of mean NRS between patients in the IV parecoxib group or IV morphine group (P = 0.095). The mean NRS for patients treated with IV morphine were 7.1 at 0 minutes, 4.5 at 5 minutes, 3.1 at 15 minutes, and 2.0 at 30 minutes. Whereas mean NRS for patients who received IV parecoxib were 7.8 at 0 minutes, 5.7 at 5 minutes, 4.7 at 15 minutes, and 3.9 at 30 minutes. The onset of perceptible analgesic effects could be seen as early as 5 minutes. Dizziness was experienced in 42.9% of patients who received IV morphine compared to none in the parecoxib group.
CONCLUSIONS: There was non-significant trend toward superiority of IV morphine over IV parecoxib. Looking at its effectiveness and the lack of opioid-related side-effects, the usage of IV parecoxib sodium may be extended further to a variety of cases in the ED.
Study site: Emergency department, Hospital Universiti Sains Malaysia (HUSM)
Fulltext Lung Ultrasonography for COVID-19 Patients in Out of Hospital Settings

Abd Wahab M, Eddie EA, Ibrahim Ahmad UQA, Shafie H, Shaikh Abd Karim SB, Abdull Wahab SF

J Ultrasound, 2022 Jan 15.
PMID: 35032294 DOI: 10.1007/s40477-021-00609-4

PURPOSE: The portability of a hand-held ultrasound allows the health care worker to conduct lung ultrasound in out-of-hospital setting. It is used as a tool to conduct staging and triaging for COVID-19 patients. This study evaluated the utilization of lung ultrasound in an out-of-hospital setting versus chest x-rays in detecting and staging of COVID-19 patients with pneumonia.
METHODS: The study was conducted among COVID-19 subjects at an out-of-hospital setting whereby lung ultrasound was done and subsequently chest x-rays were taken after being admitted to the health care facilities. Lung ultrasound findings were reviewed by emergency physicians, while the chest x-rays were reviewed by radiologists. Radiologists were blinded by the patients' lung ultrasound findings and clinical conditions. The analysis of the agreement between the lung ultrasound findings and chest x-rays was conducted.
RESULTS: A total of 261 subjects were recruited. LUS detected pulmonary infiltrative changes in more stage 3 COVID-19 subjects in comparison to chest x-rays. Multiple B-lines were the predominant findings at the right lower anterior, posterior and lateral zones. Interstitial consolidations and ground glass opacities were the predominant descriptive findings in chest x-rays. However, there was no agreement between lung ultrasound and chest x-ray findings in detecting COVID-19 pneumonia as the Cohen's Kappa coefficient was 0.08 (95% CI 0.06-0.22, p = 0.16).
CONCLUSION: The diagnostic imaging and staging of COVID-19 patients using lung ultrasound in out-of-hospital settings showed LUS detected lung pleural disease more often than CXR for stage 3 COVID-19 patients.
Fulltext Demographic and clinical characteristics of red tag patients and their one-week mortality rate from the emergency department of the Hospital Universiti Sains Malaysia

Ahmad R, Rahmat R, Hisamudin N, Rahman NA, Noh AY, Mohammad N, et al.

Southeast Asian J Trop Med Public Health, 2009 Nov;40(6):1322-30.
PMID: 20578468

Early identification and rapid treatment of red tag patients may decrease morbidity and mortality. We examined the clinical characteristics, etiologies and one week mortality rate of red tag (life threatening and potentially life threatening illness) patients at the Hospital Universiti Sains Malaysai (HUSM). A cross-sectional study was conducted at the Emergency Department of the HUSM from 1 August 2006 to 31 January 2007; 440 eligible patients were analyzed. The group had a mean age of 47.2 +/- 22 years, with 67.3% of the patients being male. Twenty-three percent were trauma cases with motor vehicle accident being the major mechanism of injury. Fifty-four percent of the cases had cardiac related illnesses. The mean duration of stay in the Emergency Department (ED) was 3.9 +/- 1.5 hours. The survival rate at one week was 76.6%. The non-trauma group comprised 74.0% of death cases. Acute coronary syndrome and road traffic accidents comprised 22.0% of total death cases at one week. Red tag patients constitute a large proportion of ED cases and may remain in the ED for significant periods of time.

Study site: Hospital Universiti Sains Malaysia (HUSM)
Fulltext The record-setting flood of 2014 in kelantan: challenges and recommendations from an emergency medicine perspective and why the medical campus stood dry

Baharuddin KA, Abdull Wahab SF, Nik Ab Rahman NH, Nik Mohamad NA, Tuan Kamauzaman TH, Md Noh AY, et al.

Malays J Med Sci, 2015 Mar-Apr;22(2):1-7.
PMID: 26023289

Floods are considered an annual natural disaster in Kelantan. However, the record-setting flood of 2014 was a 'tsunami-like disaster'. Hospital Universiti Sains Malaysia was the only fully functioning hospital in the state and had to receive and manage cases from the hospitals and clinics throughout Kelantan. The experiences, challenges, and recommendations resulting from this disaster are highlighted from an emergency medicine perspective so that future disaster preparedness is truly a preparation. The history of how the health campus was constructed with the collaboration of Perunding Alam Bina and Perkins and Willis of Chicago is elaborated.
Fulltext A multicenter controlled trial on knowledge and attitude about cardiopulmonary resuscitation among secondary school children in Malaysia

Rahman NH, Keng Sheng C, Kamauzaman TH, Md Noh AY, Wahab SF, Zaini IZ, et al.

Int J Emerg Med, 2013;6(1):37.
PMID: 24135122 DOI: 10.1186/1865-1380-6-37

We performed a multicenter controlled trial to assess the knowledge and attitude (KA) about cardiopulmonary resuscitation (CPR) among secondary school children in a district in Malaysia.